The Impact of Frailty on Changes in Physical Function Among Adults with Rheumatoid Arthritis

James Andrews¹, Laura Trupin², Catherine Hough¹, Edward H. Yelin³ and Patricia Katz², ¹Medicine, University of Washington, Seattle, WA, ²University of California San Francisco, San Francisco, CA, ³Medicine/Rheumatology, University of California San Francisco, San Francisco, CA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: patient outcomes, physical function, rheumatoid arthritis (RA) and sarcopenia

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Frailty is a state of excess vulnerability to stressors and is associated with increased risk of poor health outcomes including physical disability. Frailty and reduced physical function are common in rheumatoid arthritis (RA). However, the relationship between frailty and change in physical function over time in RA is unknown. We tested the hypothesis that frailty is a risk factor for worsening patient-reported physical function over time in RA.

Methods: Adults from a longitudinal RA cohort (n=124) participated. Using an established definition of frailty¹, individuals with 3 or more of the following physical deficits were classified as frail: 1) body mass index ≤ 18.5, 2) low grip strength (adjusted for sex and BMI, measured by handheld dynamometer), 3) severe fatigue (measured by the Fatigue Severity Inventory), 4) slow 4-meter walking speed (adjusted for sex and height), 5) low physical activity (measured by the International Physical Activity Questionnaire). Individuals with 1 or 2 deficits were classified as “pre-frail”, and those with no deficits as “robust¹.” In addition, a frailty score (0-5) was calculated based on an individual’s number of deficits. Self-reported physical function was assessed by the Health Assessment Questionnaire (HAQ) at baseline and at follow-up approximately 2 years later. Regression analyses modeled associations of baseline frailty category and frailty score with HAQ score at follow-up with and without controlling for age, sex, disease duration, C-reactive protein, use of oral steroids, and pain. In addition, regression analyses modeled the association of baseline frailty category and frailty score with development of a clinically-meaningful worsening (≥0.22) in HAQ score at follow-up with and without controlling for covariates.

Results: Among adults with RA, being frail compared to being robust was associated with a 0.42-point (CI:0.13, 0.71) worse HAQ score at follow-up (Table 1) and 11 times (CI:1.58, 76.60) the odds of developing a meaningfully worse HAQ score at follow-up (Table 2) even when adjusting for covariates. In addition, a 1-point increase in baseline frailty score was associated with a 0.12-point (CI:0.05, 0.21) worse HAQ score at follow-up (Table 1) and nearly twice (CI:1.18, 3.30) the odds of developing a meaningfully-worse HAQ score at follow-up (Table 2).

Conclusion: Frailty may be an important, identifiable, and unique risk factor for the development of physical disability in RA. Future studies should address whether modifying frailty improves physical function in RA.

Table 1: Linear Regression Coefficients (95% CIs) for the Effect of Baseline Frailty Category or Frailty Score on HAQ Scores at Follow-up among Individuals with Rheumatoid Arthritis (n=124)
	Model 1	Model 2	Model 3
Frail	0.87*** (0.45, 1.29)	0.41** (0.13, 0.69)	0.42** (0.13, 0.71)
Pre-frail	0.55*** (0.25, 0.85)	0.22* (0.03, 0.41)	0.20* (0.008, 0.39)
Robust	Reference	Reference	Reference
Frailty Score (per 1 point)	0.29*** (0.18, 0.41)	0.15*** (0.07, 0.23)	0.12** (0.05, 0.21)
Model 1: unadjusted Model 2: adjusted for baseline HAQ score Model 3: adjusted for baseline HAQ score, sex, age, baseline disease duration, hsCRP, use of oral steroids, and pain. Frail= ³3 physical deficits, Pre-frail= 1-2 physical deficits, Robust= 0 physical deficits (¹Fried LP et al., J Gerontol A Biol Sci Med Sci, 2001; 56:M146) HAQ scores are 0-3 with higher scores representing worse physical function. p<0.05, p<0.01, **p<0.001

Table 2: Odds Ratios (95% CIs) for the Effect of Baseline Frailty Category or Frailty Score on Worsening HAQ Scores at Follow-up among Individuals with Rheumatoid Arthritis (n=124)
	Model 1	Model 2	Model 3
Frail	6.22* (1.20, 32.21)	7.95* (1.40, 45.04)	11.00* (1.58, 76.60)
Pre-frail	2.99 (0.81, 11.04)	3.55 (0.91, 13.77)	3.84 (0.89, 16.50)
Robust	Reference	Reference	Reference
Frailty Score (per 1 point)	1.73* (1.13, 2.66)	1.88** (1.19, 2.96)	1.98** (1.18, 3.30)
Model 1: unadjusted Model 2: adjusted for baseline HAQ score Model 3: adjusted for baseline HAQ score, sex, age, baseline disease duration, hsCRP, use of oral steroids, and pain. Frail= ³3 physical deficits, Pre-frail= 1-2 physical deficits, Robust= 0 physical deficits (¹Fried LP et al., J Gerontol A Biol Sci Med Sci, 2001; 56:M146) HAQ scores are 0-3 with higher scores representing worse physical function. Worsening HAQ score is defined as an increase of at least 0.22, because the minimum clinically significant difference for the HAQ is 0.22. p<0.05, p<0.01, **p<0.001

Disclosure: J. Andrews, None; L. Trupin, None; C. Hough, None; E. H. Yelin, None; P. Katz, None.

To cite this abstract in AMA style:

Andrews J, Trupin L, Hough C, Yelin EH, Katz P. The Impact of Frailty on Changes in Physical Function Among Adults with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-impact-of-frailty-on-changes-in-physical-function-among-adults-with-rheumatoid-arthritis/. Accessed .

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